胰腺连续动态增强CT术前诊断胰岛素瘤的价值

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目的探讨胰腺连续动态增强CT(PDCE-CT)术前诊断胰岛素瘤的价值,以提高胰岛素瘤检测敏感性,并分析常规增强CT检测胰岛素瘤的最佳图像采集时间窗。方法回顾性分析23例经手术、病理证实的胰岛素瘤,共计17例患者行胰腺连续动态增强CT,另共计9例患者行胰腺常规增强CT(其中4例患者常规CT增强阴性者进一步行胰腺连续动态增强),比较胰腺动态增强CT与常规增强CT对胰岛素瘤术前诊断的敏感性,探究胰岛素瘤强化峰值(PH)、胰岛素瘤及周围正常胰腺组织密度差值(T-P差值)峰值以及T-P差值>35 HU的时间段,并总结胰岛素瘤CT图像特征。结果 (1)PDCE-CT与常规增强CT敏感性分别为94.1%(16/17)、55.6%(5/9),两者具有统计学差异(P=0.035,P<0.05)。(2)PDCE-CT的PH值为(174.6±45.4)HU[时间点为(23.4±13.1)s],T-P差值PH值为(65.8±34.4)HU[时间点为(32.4±12.3)s],T-P差值>35 HU时间段为25.3±14.4~51.3±18.9s。结论 PDCE-CT较常规增强CT对于术前诊断胰岛素瘤具有更好的敏感性;行常规增强CT时,在注入对比剂后25.3±14.4~51.3±18.9 s时间窗内采集图像对于术前诊断胰岛素瘤价值更大,但个体差异较大。 Objective To investigate the value of preoperative PDCE-CT for the diagnosis of insulinoma in order to improve the detection sensitivity of insulinoma, and to analyze the best image acquisition time window of conventional enhanced CT in detection of insulinoma. Methods A retrospective analysis of 23 cases of pathologically confirmed insulinoma, a total of 17 patients underwent continuous dynamic contrast-enhanced CT, and a total of 9 patients underwent routine enhanced CT (including 4 patients with conventional CT-negative further pancreatic continuous Dynamic contrast enhancement). The sensitivity of pancreatic dynamic contrast-enhanced CT and routine contrast-enhanced CT in preoperative diagnosis of insulinoma were compared. The peak of insulinoma (PH), the difference of density of insulinoma and surrounding normal pancreatic tissue (TP difference) Difference> 35 HU time period, and summary of insulinoma CT image features. Results (1) The sensitivity of PDCE-CT and conventional enhanced CT were 94.1% (16/17) and 55.6% (5/9), respectively, with statistical significance (P = 0.035, P <0.05). (2) The PH value of PDCE-CT was (174.6 ± 45.4) HU [(23.4 ± 13.1) s] and the TP difference was (65.8 ± 34.4) HU [(32.4 ± 12.3) s ], TP difference> 35 HU time period was 25.3 ± 14.4 ~ 51.3 ± 18.9s. Conclusions PDCE-CT is more sensitive than routine contrast-enhanced CT in preoperative diagnosis of insulinoma. During conventional contrast-enhanced CT, the images were taken within 25.3 ± 14.4 ~ 51.3 ± 18.9 s after injection of contrast medium. For preoperative diagnosis of insulin Tumor value greater, but individual differences.
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